Outcomes following deep hypothermic circulatory arrest versus antegrade cerebral perfusion during aortic arch reconstruction

Abstract

Objective

The optimal method for cerebral protection during aortic arch reconstruction in neonates and infants is unknown. We compare the outcomes of deep hypothermic circulatory arrest and selective antegrade cerebral perfusion strategies in neonatal and infant cardiac surgery.

Methods

We retrospectively identified all patients aged less than 1 year who underwent aortic arch reconstruction from 2012 to 2023. Patients were categorized on the cerebral perfusion strategy used during their procedure. Comparative analyses of perioperative and outcome variables were conducted to assess differences between cerebral protection strategies. A secondary analysis further stratifying by complexity of repair was performed. Examples of “complex” repair included the Norwood procedure, and “simple” repairs included isolated arch reconstructions. Adjusted regression models were used to identify specific outcomes associated with cerebral perfusion strategy used.

Results

There were 165 cases included in our cohort (114 [69%] selective antegrade cerebral perfusions and 51 [31%] deep hypothermic circulatory arrests). Overall, hospital mortality was 7% (selective antegrade cerebral perfusion 9% vs deep hypothermic circulatory arrest 2%, P = .17). There were 6 total neurologic events in 4 patients after surgery in the selective antegrade cerebral perfusion group and none in the deep hypothermic circulatory arrest group. Irrespective of the cerebral perfusion strategy, there were no differences in mortality, stroke, seizures, renal failure, and catheterization reinterventions observed after surgery. This finding held true even when stratifying cerebral perfusion methods by complexity of repair. Regression analysis showed no associations for cerebral perfusion strategy with any outcome even after adjusting for age and complexity of repair.

Conclusions

There were no significant short-term differences and a low rate of neurologic events in both groups during aortic arch reconstruction among neonates and infants. Longer follow-up is necessary to evaluate the impact of cerebral perfusion strategy on neurocognitive development later in life.